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Sex-Specific Thresholds of High-Sensitivity Troponin in Patients With Suspected Acute Coronary Syndrome

2019; Elsevier BV; Volume: 74; Issue: 16 Linguagem: Inglês

10.1016/j.jacc.2019.07.082

1558-3597

Kuan Ken Lee, Amy V. Ferry, Atul Anand, Fiona E. Strachan, Andrew R. Chapman, Dorien M. Kimenai, Steven J.R. Meex, Colin Berry, Iain Findlay, Alan Reid, Anne Cruickshank, Alasdair Gray, Paul Collinson, Fred S. Apple, David McAllister, Donogh Maguire, Keith A.A. Fox, David E. Newby, Christopher Tuck, Catriona Keerie, Christopher J. Weir, Anoop Shah, Nicholas L. Mills, Nicholas L. Mills, Fiona E. Strachan, Christopher Tuck, Anoop Shah, Atul Anand, Amy V. Ferry, Kuan Ken Lee, Andrew R. Chapman, Dennis Sandeman, Philip D. Adamson, Catherine L. Stables, Catalina A. Vallejo, Athanasios Tsanasis, Lucy Marshall, Stacey Stewart, Takeshi Fujisawa, Mischa Hautvast, Jean McPherson, Lynn McKinlay, Nicholas L. Mills, David E. Newby, Keith A.A. Fox, Colin Berry, Simon Walker, Christopher J. Weir, Ian Ford, Nicholas L. Mills, David E. Newby, Alasdair Gray, Keith A.A. Fox, Colin Berry, Simon Walker, Paul Collinson, Fred S. Apple, Alan Reid, Anne Cruikshank, Iain Findlay, Shannon Amoils, David McAllister, Donogh Maguire, Jennifer S. Stevens, John Norrie, Christopher J. Weir, Anoop Shah, Atul Anand, Andrew R. Chapman, Kuan Ken Lee, Jack Andrews, Philip D. Adamson, Alastair J. Moss, Mohamed Anwar, John Hung, Nicholas L. Mills, Simon Walker, Jonathan Malo, Alan Reid, Anne Cruikshank, Paul Collinson, Colin Fischbacher, Bernard Croal, Stephen J Leslie, Catriona Keerie, Richard A. Parker, Allan Walker, Ronnie Harkess, Christopher Tuck, Tony Wackett, Christopher J. Weir, Roma A. Armstrong, Marion Flood, Laura Stirling, Claire MacDonald, Imran Sadat, Frank Finlay, Heather Charles, Pamela Linksted, Stephen G. Young, Bill Alexander, Chris Duncan,

Cardiac Imaging and Diagnostics

Major disparities between women and men in the diagnosis, management, and outcomes of acute coronary syndrome are well recognized.The aim of this study was to evaluate the impact of implementing a high-sensitivity cardiac troponin I assay with sex-specific diagnostic thresholds for myocardial infarction in women and men with suspected acute coronary syndrome.Consecutive patients with suspected acute coronary syndrome were enrolled in a stepped-wedge, cluster-randomized controlled trial across 10 hospitals. Myocardial injury was defined as high-sensitivity cardiac troponin I concentration >99th centile of 16 ng/l in women and 34 ng/l in men. The primary outcome was recurrent myocardial infarction or cardiovascular death at 1 year.A total of 48,282 patients (47% women) were included. Use of the high-sensitivity cardiac troponin I assay with sex-specific thresholds increased myocardial injury in women by 42% and in men by 6%. Following implementation, women with myocardial injury remained less likely than men to undergo coronary revascularization (15% vs. 34%) and to receive dual antiplatelet (26% vs. 43%), statin (16% vs. 26%), or other preventive therapies (p < 0.001 for all). The primary outcome occurred in 18% (369 of 2,072) and 17% (488 of 2,919) of women with myocardial injury before and after implementation, respectively (adjusted hazard ratio: 1.11; 95% confidence interval: 0.92 to 1.33), compared with 18% (370 of 2,044) and 15% (513 of 3,325) of men (adjusted hazard ratio: 0.85; 95% confidence interval: 0.71 to 1.01).Use of sex-specific thresholds identified 5 times more additional women than men with myocardial injury. Despite this increase, women received approximately one-half the number of treatments for coronary artery disease as men, and outcomes were not improved. (High-Sensitivity Troponin in the Evaluation of Patients With Acute Coronary Syndrome [High-STEACS]; NCT01852123).